Purpose: Chronic FNV includes chronic idiopathic nausea and functional vomiting (Rome III criteria), and refers to chronic bothersome nausea and/or emesis not attributable to structural or biochemical causes. Neuromodulators (antidepressants, anticonvulsants) improve symptoms, but it is unclear if gastric emptying study (GES) results impact response. We compared outcomes in FNV subjects with and without delayed gastric emptying treated with neuromodulators. Methods: Adult subjects with FNV treated with neuromodulators and with follow-up were identified. Subjects were segregated into 3 groups, delayed GES, normal GES, and no GES. Subjects with cyclic vomiting syndrome, gastroparesis requiring nutritional support, foregut surgery, or significant systemic comorbidities were excluded. Likert scales were used to assess symptom severity at baseline (0=no symptom, 3=severe symptoms) and at follow-up (0=no improvement or worse, 3=sustained improvement or remission). Univariate and multivariate analyses were performed to assess differences between groups and predictors of response. Results: Of 94 total subjects (43.8 +1.4 yr, 79 F), 27 had delayed GES (42.7 +2.3 yr, 24 F), 15 had normal GES (40.9 +3.5 yr, 10 F), and 52 had no GES performed (45.1 +1.9 yr, 45 F). All subjects had nausea and/or vomiting; additional symptoms included pain (77.7%), bloating (37.2%), early satiety (11.7%), weight loss (43.6%); these did not differ by gastric emptying status (p>0.07 for each). Additionally, 51.1% reported psychiatric diagnoses, while 10.6% had well-controlled diabetes without neuropathy. Baseline symptomatic status was reported as 2.1 ± 0.3, similar across the three groups (p>0.10 between GES groups). Over 8.5 +1.1 months of follow-up, 72.3% achieved at least moderate symptom improvement (>2 on the Likert scale), while 22.3% achieved near-complete symptom resolution with neuromodulator therapy. Proportions achieving moderate improvement (delayed GES, 70.4%, normal GES, 80.0%, no GES, 71.2%) and mean Likert scores (1.7 +0.2, 1.9 +0.3 and 1.8 +0.1 respectively) were similar regardless of gastric emptying status (p=0.76 across groups) or medication regimen (p=0.68). On multivariate logistic regression analysis including age, gender, medication regimen, GES results, and psychiatric diagnoses, only older age (Exp [B]=1.05, p=0.008) predicted symptom response to treatment, and GES status remained insignificant. Conclusion: Symptom improvement with neuromodulator treatment may be seen independent of gastric emptying status in FNV. Almost three-quarters can expect at least moderate benefit with this approach, regardless of the neuromodulator regimen used. Delayed gastric emptying may be inherent to the functional syndrome rather than a cause for symptoms in FNV.